The ketogenic diet from A to Z

The ketogenic diet (ketogenic, fatty) has been used by doctors for many years to treat, among other things, a very specific form of drug-resistant epilepsy in children. This is probably a fact - the use of diet as a scientifically based and recognized therapeutic method is generating a lot of interest in a high-fat diet. Currently, it is not difficult to find information that the ketogenic diet is the ideal diet for people with weight loss problems, for athletes, or even people with cancer. Is the high-fat diet really the queen of diets?

What happens in our bodies on a ketogenic diet?

Evolution has adapted the human body for energy from all the macronutrients in our diet - carbohydrates, fats and proteins. One gram of carbohydrates gives us the same energy as one gram of protein (4 kcal). One gram of fat equals 9 kcal. Consequently, fat has the highest energy density, and yet the body is reluctant to get energy from it - it prefers to use carbohydrates much more and store fat in the form of adipose tissue as a reserve for "hard times".

The situation is reversed when there is not enough sugar in the diet. First, the body itself tries to produce enough glucose - it uses, among other things, the breakdown products of triglycerides or muscle proteins. By following a low-carb diet for an extended period of time, the body looks for a solution to conserve protein - the production of ketone bodies in the liver. The body's transition to ketone production is called ketosis.

Can I eat carbs on a ketogenic diet?

Ketone bodies (acetone, acetoacetic acid, beta-hydroxybutyric acid) are not ideal carriers of energy - some cells in our body, such as liver cells or red blood cells, cannot produce energy from them. This means that even when we are in a state of ketosis, we still need glucose - if we do not provide it in the form of carbohydrates from food, our body will have to produce it on its own - for example, by breaking down muscles. This is definitely a situation that everyone would rather avoid.

Therefore, a ketogenic diet cannot be a completely carbohydrate-free diet. In practice, the so-called states of ketosis can be achieved by covering our total need according to the following scheme:

• 55-60% of energy from fat,
• 30-35% of energy from proteins,
• 5-10% of energy from carbohydrates

It should be remembered that regardless of the type of diet, our body is constantly undergoing various biochemical reactions - regardless of whether we eat a lot or little sugar, our body will produce them - just like fats and proteins. Diet simply alters the intensity of various metabolic pathways, but cannot completely stop them.

Dos and Don'ts on a ketogenic diet?

According to the rule of restricting carbohydrates to an amount corresponding to 5-10% of the daily energy requirement, a person on a 2000 calorie diet can consume about 20-50 grams of carbohydrates per day. When on a ketogenic diet, remember to eat fruits and vegetables that are rich in minerals and vitamins. Both fruits and vegetables contain (sometimes relatively high) amounts of carbohydrates and sugars. When we look at any nutritional table, we quickly notice that by including the fruits and vegetables needed for health in the ketogenic diet, we should completely forget about foods high in carbohydrates, such as breads, cereals, pasta, sweets and even sweetened drinks. ...

Generally, we don't need to limit our intake of foods high in fat and protein, but here we must be smart - even if we believe that the ketogenic diet is a healthy diet, this certainly will not be the case if it is based on fried bacon. The ketogenic diet should be high in healthy fats, low in carbohydrate plants, and low in or unprocessed meats. A good supplement would be dairy (taking into account the carbohydrates it contains).

The ketogenic diet in medicine

The history of the ketogenic diet is closely related to medicine, and more specifically to the treatment of epilepsy. The ketogenic diet is used primarily in children with congenital deficiency / defect in the GLUT1 glucose transporter. GLUT1 deficiency is an incurable metabolic disease that prevents glucose from being transported to the brain. The consequences of an insufficient supply of glucose to the brain are already apparent in infants and include: microcephaly, developmental disorders, or drug-resistant seizures. The only effective therapy is the introduction of a ketogenic diet in the first days of life. Diet significantly improves most of the symptoms of the disease.

The ketogenic diet is also used for other forms of drug-resistant childhood epilepsy and in the treatment of some rare forms of metabolic disease.

The use of the ketogenic diet in medicine is very limited, and if it is indeed justified in a particular case, it will be recommended by a specialist doctor. The ketogenic diet should not be used by people who are sick on their own.

Myths about the ketogenic diet

Many myths have arisen around the ketogenic diet. It can be assumed that this is due to the recognition of the ketogenic diet by modern medicine as an effective means of treating certain diseases. So far, there have been many clinical trials on the use of the ketogenic diet and they are still underway. Unfortunately, in none of them the fat diet was not as effective as in the case of the aforementioned diseases. Many studies have even shown its negative impact on the course of certain diseases. Moreover, existing publications and studies are often misinterpreted by people outside of dietetics and medicine.

One very dangerous myth is the alleged effectiveness of the ketogenic diet in treating cancer. Indeed, research conducted so far has shown that the growth of some cancers slows after following a ketogenic diet. Unfortunately, this is not a reason for premature celebration - the same studies have shown an acceleration in the growth of other cancers, and researchers cannot answer which characteristics of cancer may determine the possible sensitivity to this type of diet. Scientists also cannot say with certainty whether the real effect of slowing down the division of cancer cells was a result of diet. Until we know the answers to these questions, it is strongly discouraged to follow a ketogenic diet for cancer.

Also, one should not assume that the ketogenic diet will cure other serious diseases - if clinical trials do demonstrate the undeniable effectiveness of this type of diet in treating any disease, then it will be recommended to patients, as in the case of the GLUT1 deficiency mentioned above.

In case of a radical change in diet, the patient should always consult a doctor or a highly qualified nutritionist.

Losing weight on a fat diet

The ketogenic diet can actually be the diet used for weight loss. Numerous studies also show the normalization of laboratory parameters associated with excess weight (cholesterol, triglycerides, insulin resistance).

It should be noted that most studies are short-term, so the effects of long-term use of a ketogenic diet on health and maintenance of weight loss are not well understood. The mechanism responsible for losing weight on a ketogenic diet is also unclear. Water loss is thought to be responsible for rapid weight loss in the first few meals - ketone bodies are diuretic.

In the long term, weight loss can be associated with:

1. a decrease in the concentration of hormones that stimulate appetite
2. direct suppression of appetite by ketone bodies
3. persistent feeling of fullness after eating fatty foods and unconsciously reducing the amount of calories consumed
4. lowering insulin levels, which stimulates the "burning" of adipose tissue

The ketogenic diet can be used successfully to reduce body fat in healthy people and for a short period of time (most of the available studies are less than 12 weeks long). You should refrain from continuing the diet when side effects typical for it appear.

Risks associated with following a ketogenic diet

The main risk associated with a ketogenic diet is the great difficulty in providing the right amount of micronutrients - minerals and vitamins. The ketogenic diet (due to the limited amount of carbohydrates consumed) is a diet low in grains, fruits and vegetables - important sources of micronutrients. The ketogenic diet must be very thoughtful and carried out under optimal conditions under the supervision of a dietitian.

There are other risks associated with following a ketogenic diet. These include, among others:

1. increased levels of uric acid in the blood (risk of gout)
2. increased risk of developing kidney stones
3. increased development of osteoporosis
4. chronic fatigue
5. constipation, diarrhea
6. vomiting
7. ketoacidosis (in people with diabetes)

Once again, it should be emphasized that both positive and negative effects of the ketogenic diet have been observed mainly in short studies. Thus, it is impossible to unequivocally answer the question of whether the same risk and benefit profile applies to long-term dietary use.

Who shouldn't follow a ketogenic diet

Children, the elderly, and the chronically ill should definitely not be on a ketogenic diet.

People with medical conditions should not follow a ketogenic diet:

1. with diseases of the digestive system (for example, malabsorption),
2. with metabolic diseases (unless a ketogenic diet is a medical indication in their case)
3. with osteoporosis
4. with gout
5. with kidney house
6. with diabetes

So who is the ketogenic diet for?

Unfortunately, there is no answer to this question. It should be borne in mind that although the ketogenic diet is known in medicine and has been studied in dozens, if not hundreds of studies, still not everything is known about it. Of course, when used briefly by young, healthy people, it can have positive effects, such as losing fat while maintaining muscle mass. On the other hand, there is no lack of scientific evidence for skepticism.

The ketogenic diet is not recommended for daily use by nutritionists. It also hasn't received positive reviews from the medical community, and most of the rave reviews come directly from high-fat diets. This is not surprising - everyone who, for health reasons, adheres to a certain diet, consider it the healthiest one - otherwise they would not have started using it. If we separate private opinions from the objective observations of scientists in the field of medicine and nutrition, we come to the conclusion that the transition to a ketogenic diet is a kind of experiment. An experiment in which we are guinea pigs.